Ovarian Transplantation Between Monozygotic Twins Discordant for Premature Ovarian Failure

Abstract

A number of studies in sterilized animals have shown that ovarian grafts are able to restore ovarian function and fertility. Today, more women are surviving cancer, but some are made sterile by radiotherapy or gonadotoxic chemotherapy. Should it prove safe and effective to transplant ovarian tissue in humans, it may be possible to preserve fertility in these women and also those who want to delay childbearing for either medical or social reasons. The investigators report an attempt at ovarian transplantation between healthy monozygotic twins, one of whom had premature menopause. The monozygotic twin sisters were 24 years of age at the time. One of them, the donor, had three naturally conceived children. The other twin had developed secondary amenorrhea at age 14 after 3 years of scanty menses. Laparoscopy and ovarian biopsy at age 20 had disclosed atrophic, so-called “streak” gonads with no follicles. Two cycles of in vitro fertilization at age 23 had failed, and the sisters wanted not to have further tries at egg donation. Instead, the sterile twin received a transplant of cortical ovarian tissue from her donor sister by means of minilaparotomy. Ovarian tissue was trimmed until 1 to 2 mm thick and, after removing the recipient’s streak ovaries, approximately one third of the donor’s ovarian cortex was laid over the medulla of each ovary and sutured in place. The remaining third was cryopreserved. The recipient twin had menses 80 days postoperatively. A 14-mm follicle was found by sonography approximately 10 weeks postoperatively. Gonadotropin levels had declined 20 weeks after the procedure, and the patient had a heavy menstrual period. She conceived during the second cycle and, after an uneventful pregnancy, delivered a healthy-appearing female infant at 38 weeks gestation. This situation will not arise often, but the results may apply more broadly to preserving fertility in young women such as those whose cancer treatment may result in sterility.